title: Asthma Severity in patients initiating controller monotherapy versus combination therapy.
abstract: BACKGROUND
  Asthma treatment guidelines recommend medications based on the level of asthma control.
  
  
  OBJECTIVE
  To evaluate differences in asthma control between patients who initiated asthma controller monotherapy versus combination therapy.
  
  
  METHODS
  Children (5-16 years; n = 488) and adults (17-80 years; n = 530) with asthma and no controller therapy in the prior 6 months were included. Telephone surveys were conducted within 5 days of filling a new asthma controller prescription with either the caregiver of children or the adult patient. Demographics, asthma control before therapy, and asthma-related resource use were assessed for patients initiating monotherapy (filling one asthma controller prescription) and combination therapy (filling more than one controller medication or a fixed-dose combination).
  
  
  RESULTS
  Mean pediatric age was 10 years; 53% were male. Mean adult age was 47 years; 25% were male. There were no significant differences in asthma control score between patients receiving monotherapy and combination therapy. Children on combination therapy did not have more nighttime awakening or short-acting β-agonist use but were more likely to have been hospitalized due to asthma attack (p = .05) and have more unscheduled (p = .0374) and scheduled (p = .009) physician visits. Adults on combination therapy were more likely to have been hospitalized due to asthma attack (p < .05) and have regular doctor visits for asthma (p < .01).
  
  
  CONCLUSIONS
  Assessment of asthma control scores in the 4 weeks before index medication suggests that asthma severity during a treatment-free period did not differ significantly for patients initiating controller monotherapy versus combination therapy. From these findings, it appears that although physicians may not focus on asthma control when choosing the intensity of initial controller therapy, the intensity of health-care encounters may be an influence.
authors.affiliation: Pulmonary and Critical Care Medicine, The Johns Hopkins University, Baltimore, MD 21205, USA. gdiette@jhmi.edu
authors.forename: Gregory B
authors.initials: GB
authors.lastname: Diette
authors.forename: Anne L
authors.initials: AL
authors.lastname: Fuhlbrigge
authors.forename: Felicia
authors.initials: F
authors.lastname: Allen-Ramey
authors.forename: April
authors.initials: A
authors.lastname: Hopper
authors.forename: Shiva G
authors.initials: SG
authors.lastname: Sajjan
authors.forename: Leona E
authors.initials: LE
authors.lastname: Markson
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004338:Drug Combinations; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004359:Drug Therapy, Combination / Q000706:statistics & numerical data; D004777:Environment; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D058007:Physicians, Primary Care / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists; D018927:Anti-Asthmatic Agents; D004338:Drug Combinations; D020024:Leukotriene Antagonists